Time-Saving Pearls for Implanting Dexycu, Dextenza, and Durysta

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Drs. Radcliffe, Gupta, and Singh review clinical pearls for ophthalmologists on how to implant Dexycu, Dextenza, and Durysta.

Drs. Radcliffe, Gupta, and Singh walk through surgical videos of them inserting Dexycu (dexamethasone intraocular suspension 9%, EyePoint Pharmaceuticals), Dextenza (dexamethasone ophthalmic insert 0.4mg, Ocular Therapeutix), and Durysta (bimatoprost intracameral implant 10mcg, Allergan, An AbbVie Company), respectively, while discussing surgical pearls based on their personal implantation techniques.

Interventional Mindset is an educational series that gives eye physicians the needed knowledge, edge, and confidence in mastering new technology to grow their practices and provide the highest level of patient care. Our focus is to reduce frustrations associated with adopting new technology by building confidence in your skills to drive transformation.

Browse through our videos on a variety of topics within cataract and refractive surgery, glaucoma, and ocular surface disease to learn practical insights into adopting a variety of new surgical techniques and technology.

Intravitreal Dexycu injection at the time of cataract surgery

To initiate the Dexycu placement, Dr. Radcliffe hydrates the main wounds, moves 3mm posterior to the limbus, and then injects Dexycu while visualizing the needle in the anterior vitreous. He added that during the injection, it is possible to see the dexamethasone bubble form in the vitreous.
Once the needle is withdrawn, the bubble settles inferiorly, which can reduce the potential for the patient to visualize Dexycu as a floater. Based on Dr. Radcliffe’s surgical experience post-operatively, he noted during slit lamp examination that Dexycu tends to stay in the peripheral vitreous until it is resorbed. Then, switching injection sites, Dr. Radcliffe injected additional Dexycu subconjunctivally, which tends to fully resorb after 1 week.
As antibiotic prophylaxis after cataract surgery is an integral part of Dr. Radcliffe’s surgical protocol, following cataract extraction and Dexycu placement, he builds an injection of intracameral moxifloxacin (using a 25 or 30G needle), along with subconjunctival ANCEF (cefazolin, GlaxoSmithKline) for a dropless cataract surgery.

Dextenza insertion with viscoelastic at the time of cataract surgery

Prior to inserting Dextenza, Dr. Gupta advised surgeons to make sure that the incisions are closed and the intracameral antibiotic has already been administered. Subsequently, she prefers to pull the drape away from the eye, gently pull the lid laterally, and dry the puncta to ensure the removal of any debris or residual mucus.
Next, with a dilator, Dr. Gupta approached the puncta with a horizontal and flat technique to dilate it, and she then adds viscoelastic to the puncta for lubrication. She mentioned that in her experience, the treatment outcome is not impacted by the brand of the viscoelastic (such as ProVisc [Alcon] or StableVisc [B+L]), as any cohesive viscoelastic will work. The key is to avoid adding too much viscoelastic to the puncta to prevent building too much pressure in the canalicular system.
Lastly, Dr. Gupta gently inserts the Dextenza into the puncta, sliding it in easily without excessive force.

Insertion of Durysta at the slit lamp

In the next video, Dr. Singh presented a slit lamp video of Durysta insertion, in which he uses a 20G needle loaded with Durysta, placing the needle anterior to the limbal vessels and parallel to the iris. He then pushes the needle into the anterior chamber about two bevel lengths, releases the implant, and withdraws. This marked the end of the procedure, as the implant will sink to the bottom (and out of view of the patient) with gravity.
Due to the fact that this can be a straightforward procedure, Dr. Singh highlighted that many patients perceive it to be similar to an intraocular pressure (IOP) check or eye exam, making the acceptance rate comparatively high. Further, the longevity of the medication is also generally not an issue for patients because the insertion is simple and relatively painless. Consequently, patients tend to be more open to the procedure since the bioerodible preservative-free implant can remain active for up to 4 to 6 months.


By employing the aforementioned surgical pearls for implanting Dexycu, Dextenza, and Durysta, surgeons will be able to maximize their effects with quick and proper placement with practice.

Disclaimer: Dexycu (dexamethasone ophthalmic suspension) 9% from EyePoint Pharmaceuticals is an injectable, single-dose, sustained-release medication indicated for the treatment of post-operative inflammation. Dextenza (dexamethasone ophthalmic insert) 0.4mg from Ocular Therapeutix is a preservative-free intracanalicular insert indicated for the treatment of post-operative inflammation and ocular allergy management. Durysta (bimatoprost intracameral implant) 10mcg from Allergan is a dissolvable preservative-free ocular implant indicated for the reduction of IOP in patients with open-angle glaucoma or ocular hypertension. The medical opinions and views expressed in this article are those of Preeya K. Gupta, MD, I. Paul Singh, MD, and Nathan Radcliffe, MD.

Nathan Radcliffe, MD
About Nathan Radcliffe, MD

Nathan M. Radcliffe, M.D. is a highly-experienced glaucoma and cataract surgeon.

Dr. Radcliffe graduated Alpha Omega Alpha from the Temple University School of Medicine and was named transitional resident of the year at the University of Hawaii in Honolulu. He was Chief Resident at New York University for his ophthalmology residency and Chief Glaucoma Fellow at the New York Eye and Ear Infirmary.

He was the Director of the Glaucoma Services at NYU and Bellevue hospital and currently, is part of the advanced Microincisional Glaucoma Surgery Center at New York Eye and Ear Infirmary. Dr. Radcliffe is unique because he is active in both academic and private practice settings. He is a microincisional glaucoma surgery (MIGS) innovator and instructor and has given lectures all over the United States.

Dr. Radcliffe was the first surgeon in New York to offer patients the CyPass Supraciliary Microstent, the Kahook Dual Blade Goniotomy, Visco 360 and Trab 360, the G6 micropulse laser, and Allergan’s Xen subconjunctival implant.

Dr. Radcliffe has managed some of the most difficult glaucoma and cataract cases from all over the world and is truly able to offer a tailored glaucoma and cataract surgery to his patients, being able to perform all of the available glaucoma surgeries that are currently FDA approved, and knowing the procedures and the efficacy and safety data well enough to correlate the optimal procedure with the patient’s disease.

Nathan Radcliffe, MD
Preeya K. Gupta, MD
About Preeya K. Gupta, MD

Dr. Gupta earned her medical degree at Northwestern University’s Feinberg School of Medicine in Chicago, and graduated with Alpha Omega Alpha honors. She fulfilled her residency in ophthalmology at Duke University Eye Center in Durham, North Carolina, where she earned the K. Alexander Dastgheib Surgical Excellence Award, and then completed a fellowship in Cornea and Refractive Surgery at Minnesota Eye Consultants in Minneapolis. She served on the faculty at Duke University Eye Center in Durham, North Carolina as a Tenured Associate Professor of Ophthalmology from 2011-2021.

Dr. Gupta has authored many articles in the peer-reviewed literature and serves as an invited reviewer to journals such as Ophthalmology, American Journal of Ophthalmology, and Journal of Refractive Surgery. She has also written several book chapters about corneal disease and ophthalmic surgery, as well as served as an editor of the well-known series, Curbside Consultation in Cataract Surgery. She also holds several editorial board positions.

Dr. Gupta serves as an elected member of the American Society of Cataract and Refractive Surgery (ASCRS) Refractive Surgery clinical committee, and is also is the Past-President of the Vanguard Ophthalmology Society. She gives presentations both nationally and internationally, and has been awarded the National Millennial Eye Outstanding Female in Ophthalmology Award, American Academy of Ophthalmology (AAO) Achievement Award, and selected to the Ophthalmologist Power List.

Preeya K. Gupta, MD
I. Paul Singh, MD
About I. Paul Singh, MD

Dr. I. Paul Singh, MD, is a glaucoma specialist. He completed his residency at Cook County Hospital – Division of Ophthalmology, completed his internship at Michael Reese Hospital – Department of Medicine, and completed his fellowship in Glaucoma at Duke University. Dr. Singh is actively involved in clinical research and has presented his research at national meetings and universities and published papers in many ophthalmology journals.

Dr. Singh was the first ophthalmologist in Wisconsin to implant the iStent, a device designed to treat glaucoma. He also pioneered the use of in-office lasers to remove visually significant floaters. Recently, he was instrumental in bringing laser assisted cataract surgery to the area. He enjoys giving lectures and teaching seminars around the globe to help other doctors adopt these and other newer technologies and techniques.

I. Paul Singh, MD
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